Drug Information

Common brand names:

Summary of Interactions with Vitamins, Herbs, & Foods

Replenish Depleted Nutrients

A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function. In addition, treatment with amitriptyline has been associated with a reduction in CoQ10 levels. It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30-100 mg of CoQ10 per day.

Reduce Side Effects

none

Support Medicine

L-Tryptophan and Vitamin B3

Combination of 6 grams per day L-tryptophan and 1,500 mg per day niacinamide (a form of vitamin B3) with imipramine has shown to be more effective than imipramine alone for people with bipolar disorder. These levels did not improve the effects of imipramine in people with depression. Lower amounts (4 grams per day of L-tryptophan and 1,000 mg per day of niacinamide) did show some tendency to enhance the effect of imipramine.

The importance of the amount of L-tryptophan was confirmed in other studies, suggesting that if too much L-tryptophan (6 grams per day) is used, it is not beneficial, while levels around 4 grams per day may make tricyclic antidepressants work better.

In a preliminary trial, an extract of periwinkle called vinpocetine was shown to produce minor improvements in short-term memory among people taking flunitrazepam, a benzodiazepine. Further study is needed to determine if vinpocetine would be a helpful adjunct to use of benzodiazepines.

Giving 10 mg per day each of vitamins B1, B2, and B6 to elderly, depressed persons already on tricyclic antidepressants improved their depression and ability to think more than placebo did. The subjects in this study were institutionalized, so it is unclear if these results apply to persons living at home.

Reduces Effectiveness

Black Tea

Brewed black tea (Camellia sinensis) has been reported to cause precipitation of amitriptyline and imipramine in a test tube. If this reaction occurred in the body, it could decrease absorption of these drugs. Until more is known, it makes sense to sePte ingestion of tea and tricyclic antidepressants by at least two hours.

Potential Negative Interaction

Preliminary research has suggested that St. John's wort (Hypericum perforatum) may reduce blood levels of the tricyclic antidepressant amitriptyline. This may have occurred because certain chemicals found in St. John's wort activate liver enzymes that are involved in the elimination of some drugs. Until more is known, people taking tricyclic antidepressants should avoid St. John's wort.

Kava (Piper methysticum) is an herb used to treat anxiety disorder. One individual who took a benzodiazepine (alprazolam) and kava together, along with two other medications (cimetidine and terazosin) was hospitalized in a lethargic and disoriented condition. Further research is needed to determine whether the combination of kava and benzodiazepines produces an adverse interaction. However, individuals should not take benzodiazepines and kava together unless supervised by a doctor.

Explanation Required

SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections. Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article. The Healthnotes knowledgebase does not contain every possible interaction.

The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2017.

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